With the increasing prevalence of type 2 diabetes (T2DM) in youth, and the potential for these youth to experience the devastating complications of diabetes at an early age, new approaches to diabetes prevention must be developed and tested. In this investigation we propose to: (1) Using a prospective, randomized clinical trial design, we will determine the effect of school-based, multifaceted intervention (nutrition and exercise education, coping skills training, Advanced Practice Nurse (APN) coaching, and infrastructure change) on Body Mass Index (BMI), insulin resistance, adiposity, lipids, health behaviors, depression, and self-efficacy in inner city youth at high risk for T2DM. Responses in the experimental group over 12 months will be compared to those youth who receive a delayed intervention. (2) Secondarily, we will examine the effects of baseline characteristics (age, gender, baseline health behaviors, depression) and family behaviors on the response to the intervention; and (3) Finally, we will explore the experience of youth and family in management of obesity and insulin resistance in the prevention of type 2. To achieve these aims, we will enroll 240 high-risk 6th grade middle school youth. High risk is defined as BMI >85th percentile. Schools will be randomized to experimental or delayed intervention conditions. The experimental intervention is a community-based, multifaceted intervention program that we have extensively pilot-tested and will be conducted in the middle schools in the very high-risk community of New Haven. Data will be collected pre intervention and at 4 and 13 months following using the primary outcome of BMI, insulin resistance. Revised Godin-Shephard Activity Survey and accelerometer data, Eating Habits Questionnaire, Health Behavior Questionnaire, Children's Depression Inventory for the youths and the Health Promoting Lifestyle Profile for the parents. A purposive sample of families will participate in a series of open-ended interviews. Analyses will include repeated measures ANOVA generalized estimating equation method, and grounded theory approaches. It is expected that this important and timely study will provide valuable information to help youth manage obesity, and potentially prevent T2DM and its long-term physical and psychosocial complications. [unreadable] [unreadable]